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IrQROFFICE USE: - - ------ - ----------------- ---------------------------------------- -----------------_.............._-..______---..__-_. ...... APPLICATION FOR SANITATION PERMIT Permit No. -------- - - ------------ ---- ------------- - ------ (Complefe-in Duplicate) ---------------- --- ------ ?` This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to th(e San Joaquin Local,-11efh,District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinaralnce No. 549. JOB ADDRESS AND LOCATION . _ --s-s-C_A_1_01�• Owner's Name------------- ------PR-U----------- F__i Q4#�'�!I _ - ---- -- ' - Phone--------------------------- Address � x�..i _:_. a_ .� ------------------ ----- Contractor's Name---jE'11 I1FE ------•------ ------------ ---------------- Phone--- Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court ❑ Motel ❑ O her ❑ Number of living units: __ _._ Number of bedrooms -3... Number of baths _`r` Lot size ....t -.liQ©•. --------------- Water Supply: Public system ❑� Commuhity system [] Private 61-'6epth to Water Table -', ft's Character of soil to a depth of 3 fe t• Sand ❑ Gravel ❑ Sandy Loam p Clay Loam 0/Clay ❑ Adobe, Hardpan Previous Application Made: (Ili yes date.. _. ) No E© NewtConstruction: Yes ❑ No ❑ FHA/VA:Yes ❑ No E]t TYPE OF INSTALLATION AND;SPECIFIC'A'TIONS: f ;. V (No�septic-tank or`cesspoalOerrliittedvj�tpublic-sewer is availeble-wifhin+200-feet.) r } i - -`------ ----Size.-----_-- -----------one foundation--------------------Materia!--------- �------------- --------'--- -----' � . Septic Tank: Distance from nearest well Distance fr I i �� I✓�QT1 tJ� No. of compartments'- - -- ---=---Liquid depth Capacity I a + 1 Disposal Field: Distance from nearest well :...1_Distance from foundation----__._--:-----_...Distance to nearest lot line_________________ t G7 ] r 1�, Number of lines .... ...........-- LengthLofy=each line.. .----------------------- Width of trench. Type of filterlmateriaL_____________ _!_...._Depth�ofefiltdr materiaf--__-_----------------- at! Seepage Pit: Distance to nearest well_.- _.)--.--.--_'s bistance from foundation-__-_._....._..Distance to nearest lot line..__-------_. ter ; ,n ❑�i Number of pits---t___./-______-.-Lining rnaferial__ -Q Size: Diameter_ �[}_ _. ---------------- -`- ------------ Cesspool: Distance from nearest well --------:A t= i'stance from foundation_..._._.-.1.. Lining material<-----------------------'----------- ❑ Size: Diamet'r- -- ------- ------ ------------ ---Depth--------------- ------ ------------- -----.-Liquid Capacity gals. Privy: Distance from nearest well._.--_-...._..-___....__-_-_ Distance from' nearest building k ---------- - i g------------ - -----------------'------' - I ❑ Distance totneareIst lot line -------------------------------'-'-------- Grt --------------------- ---' --------------- i Remodeling and/or repairing (describe):...........................----------------------- I ---------------- •- -- ------------------- - ---- --- --------------------------------------------- ------------------------------------------------- --------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be' done in accordance with San Joaquin County ordinances, State laws, and rule`s•!and,regulations of the San Joaquin Local Health District. -- t � (Signed)-- ' ( ' : -----i 1 ---------1---�--,-1-�- ---------------- -- -------------- ------------- ------- i ----" ............ -- Owner and/or Contractor) or) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.; can be placed on reverse side). m i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__. _.. !-- -,l� lop---------------- --------------------DATE-------- - ----------------------- REVIEWED BY---------------------- -------------------- -- --------- • DATE ------------------------------------- BUILDING PERMIT ISSUED-------- -`' ------------------------------------ - DATE--- • - ------------•------ -- ------------ :- Alterations and/or recommendations:----------------- -------- ___-------------- ----------------------------------. 7 S _Z� a --------------------------------------------- .................. -----.---____. � . .... O 1 FINAL INSPt It --- ----- . ... PZ3 --6 Date---- ----------- SAN -----SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 Wast Oak Street 124 Sycamore Street 20i West 9th Street Stockton,California Lodi. California { Manteca,California Tracy,California E.H,9 2M 1.67 Vanguard Press P Q